Article

OBJECTIVE: To systematically review randomized controlled trials of botulinum
neurotoxin for limb spasticity to determine whether different injection
techniques affect spasticity outcomes. METHODS: MEDLINE, EMBASE, CINAHL, and
Cochrane Central Register of Controlled Trials electronic databases were searched
for English language human randomized controlled trials from 1990 to 13 May 2016.
Studies were assessed in duplicate for data extraction and risk of bias using the
Physiotherapy Evidence Database scale and graded according to Sackett's levels of
evidence. RESULTS: Nine of 347 studies screened met selection criteria. Four
categories of botulinum neurotoxin injection techniques were identified: (1)
injection localization technique; (2) injection site selection; (3) injectate
volume; (4) injection volume and site selection. There is level 1 evidence that:
ultrasound, electromyography, and electrostimulation are superior to manual
needle placement; endplate injections improve outcomes vs. multisite quadrant
injections; motor point injections are equivalent to multisite injections; high
volume injections are similar to low volume injections; and high volume
injections distant from the endplate are more efficacious than low volumes closer
to the endplate. CONCLUSION: Level 1 evidence exists for differences in treatment
outcomes using specific botulinum neurotoxin injection techniques. Findings are
based on single studies that require independent replication and further study.

Langue : ANGLAIS